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ERISA: Does it Apply to Your Insurance Policy?

The Employee Retirement Income Security Act of 1974 (“ERISA”) is a complicated federal law that applies to many insurance policies—including health insurance, long-term or short-term disability insurance, and life insurance plans.

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If your insurance company denied your insurance claim, ERISA may apply to your claim. ERISA has strict requirements, including what you are required to do to appeal your claim, and what you must do before filing a lawsuit. Furthermore, ERISA takes away many of the rights and tools you typically have in a normal lawsuit to gather evidence and to prove your case.

Most people, including the majority of attorneys, have never heard of nor are familiar with ERISA. Unfortunately, many people try to appeal their denied insurance claims on their own, or will hire an attorney who is not familiar with ERISA. Due to their lack of knowledge, experience, and expertise, such individuals and attorneys make mistakes which result in the dismissal of their case—which could have been avoided.

What insurance policies does ERISA apply to? Generally, ERISA applies to all private sector employer provided insurance plans. See 29 U.S.C. § 1003. In other words, it typically does not apply to government employee provided insurance plans. See id. Nevertheless, the exceptions are fact specific. Therefore, you should consult with an attorney knowledgeable with insurance denials and ERISA.

At Head Law, we are experienced with ERISA. Furthermore, we understand the impact an insurance claim denial has on you and your family, and what evidence is necessary for your case to succeed in the internal appeals process and in a lawsuit in federal court.